The Complexity Behind Quality Measures

Professionals in the Waltham, Mass.-based Emerging Practices group at the Falls Church, Va.-based CSC have recently released a new report, “Hospital Quality Reporting-The Hidden Requirements of Meaningful Use.” In the report, authors Jane Metzger, Melissa Ames, and Jared Rhoades articulate an analysis they've done of the 15 quality reporting measures for hospitals put forward in the final rule around meaningful use, released July 13, in accordance with the unfolding sets of requirements under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act.

In their analysis, Metzger, Ames, and Rhoades find that “Simply meeting the Stage 1 functional requirements for data capture in meaningful use will only cover 35 percent of the unique data elements needed for the 15 required quality measures.” In fact, they note, “The biggest challenge involving the rest of the data elements is that they require physician documentation and electronic medication administration, not just in the hospital, but also in the ED.” They term these required data elements the “hidden functional requirements of Stage 1 meaningful use.”

THE ONLY WAY TO GET A REAL ANSWER TO THE QUESTION OF WHAT WILL ACTUALLY BE REQUIRED TO MEET THESE REQUIREMENTS IS TO GO TO THE MEASURE SPECIFICATIONS AND DECONSTRUCT THE QUALITY MEASURES INTO THEIR UNIQUE DATA ELEMENTS; AND THAT'S WHAT WE DID.

In fact, as Metzger and her co-authors note in their report, the titles of the “15” required measures listed in the final rule make them appear much simpler than they really are. Once one deconstructs-as they have in their report-the measures into the unique data elements described in the measure specifications, it becomes clear that many more data elements are actually required.

Even for such ostensibly straightforward elements as the provision of VTE (venous thromboembolism) prophylaxis, the reality of what is required evinces manifold greater levels of process and IT complexity that appears at the surface level. It also becomes clear that without computerized physician order entry (CPOE) beyond medication ordering, at least some physician documentation, and electronic medication administration record (eMAR) systems, the full data set will not be available in the electronic health record (EHR) as required for meaningful use. The fact that some data involve care in the ED or surgical suite/OR adds to the challenge.

Lead author Metzger spoke exclusively with HCI Editor-in-Chief Mark Hagland on the threshold of the public release of this report. Below are excerpts from that industry-exclusive interview.

Healthcare Informatics: Reading your report, one is struck by the tremendous amount of complexity lurking just below the surface when it comes to satisfying these meaningful use requirements; it's really quite astonishing.

Jane Metzger: Well, think of it this way. If you look at quality reporting, what will any hospital already have in electronic form? A fair amount. But the only way to get a real answer to the question of what will actually be required to meet these requirements is to go to the measure specifications and deconstruct the quality measures into their unique data elements; and that's what we did.

HCI: Was that difficult to do?

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